“How old are you?” he queried.

“I’m 29.”

“What kind of car do you drive?” he continued.

“Um, a Toyota MR2.”

“Is that a sports car?”

“Yes.”

“What colour is it?”

“Dark blue.”

He grinned and sat down, apparently satisfied with my answers.

I nodded at a tiny girl in the front row who was desperately waving her hands in the air.

“Is Mrs. Gray really your mommy?” she asked.

“Yes, she is.”

“Is she nice at home?”

“Yes, she’s very nice.”

She smiled and sat down.

I pointed to a boy who was wriggling around on his mat like a worm.

“What would you like to know?” I inquired.

“Can I go to the bathroom?”

“Okay.”

He sprinted out of the gym.

I made eye contact with a girl near the back of the room. She squealed with delight and jumped up.

“I have a cat named Trixie!” she proclaimed triumphantly.

The audience went berserk.

“I have a dog named Rover!”

“I have a goldfish named Gipper!”

“We had a bird, but it died!”

“We’re getting a salamander next week!”

“My dog just had puppies!”

“QUIET PLEASE!” yelled the principal. “No more talk about pets! Does anyone have any questions about hospitals or medicine for Dr. Gray?”

Silence.

Approximately 15 seconds later a solitary hand went up.

“Yes?” I asked cautiously.

“My grandfather lives in Nova Scotia!”

Uh-oh…  .

“We went to Disney World last summer!”

“I like Donald Duck!”

“My mommy just had a baby!”

“My dad thinks our cat might be pregnant!”

“Trixie has orange fur!”

“CHILDREN, PLEASE!” screeched the principal.

It was the longest 20 minutes of my life!

Life During Wartime

What can I say about ER work? It’s exhilarating, terrifying and hilarious, all at the same time. Like a handful of other strange professions (for some reason law enforcement and stunt acting come to mind) it’s impossible to predict what you’ll end up seeing over the course of your day. The only thing you can be reasonably sure of is that at some point during each shift you’ll run into something you’ve never laid eyes on before. Sure, there are a number of common ailments that trundle through those annoying sliding doors on a regular basis, but the red neon Emergency sign out front also seems to be a magnet for the bizarre. For example, yesterday I treated a woman who had been bitten on the cheek by a horse. Hmm, a horse bite in the middle of the city. Now there’s something you don’t see every day!

The typical shift in your average urban ER is fairly busy. For starters, you generally have anywhere from 15 to 30 patients tucked under your wing at any given time. It’s a heterogeneous group populated by the “worried well” at one end of the spectrum and the seriously ill at the other. Your job as an ER doc is to figure out what’s wrong with each patient as quickly as possible and then either fix them or relay them on to someone who can. As you work through each individual’s problems you also need to keep updating your mental tally of where all your other patients are in their respective diagnostic workups. Depending on each person’s description of their symptoms, their physical findings, the results of any tests ordered, and your instinctive gut feeling, certain illnesses move up or down their list of conceivable diagnoses. Once you’ve decided on the most likely culprit you can commence treatment and begin working on disposition. Walk-ins, crawl-ins and ambulance drop-offs add new patients to the already volatile mix every few minutes. If anyone in your flock takes a sudden nosedive you need to immediately drop everything and divert your full attention to the new priority. It’s not that uncommon to be hastily summoned to the stretcher or bedside of an unfamiliar patient who is only a few heartbeats away from death. In those cases you don’t have the luxury of being able to obtain a detailed history and perform a thorough examination to help shape a logical working diagnosis. Instead you have to immediately shift into augenblick mode and initiate potentially life-altering treatments based solely on a brief gestalt impression. It's like going from zero to warp speed without even having time to buckle in.

Imagine doing all of this in a cacophonic environment full of telephones ringing, faxes printing, monitors alarming and dozens of people laughing, crying, yelling, cursing, complaining, wheezing, coughing, bleeding and vomiting. I keep picturing some poor slob in a white lab coat juggling 20 buzzing chainsaws while balancing on a tightrope suspended above a shark-infested pool. Who could resist a job like that?

The Cleanest Boy Ever

Last Wednesday the ER was a non-stop frenetic cabaret of diseases of every genre. Around 2:00 in the afternoon one of the nurses handed me a chart and said: “I think you should see this one next.” A cursory review of the triage note revealed my next patient to be a four-year-old boy named Simon who was presenting with a rash. Meh. What’s so exciting about that?

I walked into the cubicle and came face to face with Lobster Boy. This poor little tyke was P.T. Barnum sideshow material. His entire body was covered in a brilliant red, swollen rash, and he was scratching like there was no tomorrow. Each time his nails scraped across his skin, huge welts bubbled up almost immediately. I had to force myself not to gawp.

“How long has he been like this?” I asked his mother.

“It started this morning, doctor.”

“This looks like an allergic rash. Does he have any allergies that you’re aware of?”

“No.”

“Has he been in contact with anything different lately? Food, clothing, detergent, medication?”

“No.”

“Nothing at all that might have irritated his skin?”

“Not that I can think of.”

I couldn’t make sense of it. Allergic rashes as startling as this one usually have a readily identifiable precipitant. Examining him didn’t reveal any further clues. I asked his nurse to start an IV and administer some corticosteroids and antihistamines. Two hours later he was looking and feeling much better. I decided to allow him to go home on oral medications, provided his mother promised to bring him back in the morning so I could recheck him.

The next day it was his dad who accompanied him. Once again he was covered head to toe in the same horrific scarlet rash. I asked his father if he could think of anything his son might be reacting to.

“Well, I suppose he could be allergic to those magic markers he was playing with yesterday,” he speculated. “He got marker all over his body – his arms, legs, face, belly…everywhere! The rash started about an hour after that.”

“Ah, that’s probably what triggered it,” I said with satisfaction. Another mystery solved.

“I don’t really see how, though,” he continued. “He’s played with those markers lots before, and besides, the ink wasn’t on his skin for very long. The minute my wife saw what a mess he was she marched him straight up to the bathroom and washed it all off.”

“Hmm,” I said. “Perhaps it’s not the markers, then. Could it be the soap she used that irritated his skin?”

“Oh, she didn’t use soap, doc.”

“What did she use?”

“Fantastik.”

“She used Fantastik?”

“Yeah.”

“Are you talking about the spray-on cleaner? The stuff you clean countertops and stoves with?”

“Yeah, that’s it. She sprayed him down in the bathtub and then scrubbed the marker off with a rag. That stuff really works!”

“That stuff is corrosive! It dissolves glass!”

“Hey! Maybe that’s why he’s been so itchy!”